Why does it still take so long to get a COVID-19 PCR test result?

New COVID-19 restrictions for international travel and other activities are fueling consumer demand for highly accurate polymerase chain reaction, or PCR, tests with rapid turnaround times. Some clinics can deliver a PCR test result within hours, which these days can be as essential as a plane ticket for air travel. The downside? It will likely cost you hundreds of dollars.

The molecular-based tests, considered the gold standard for detecting COVID-19, are a reliable tool but can take days to process, particularly as cases of the virus surge and people queue up for testing. Unlike less accurate antigen tests, which can be used at the point of care and deliver results within minutes, PCR tests typically require the use of lab equipment as well as technicians who are trained to process and interpret the results. Clinics with their own onsite labs can process results more quickly. 

COVID-19 testing has spawned a veritable cottage industry, with medically minded entrepreneurs stepping up to meet increased demand — often charging top dollar to expedite PCR test results. 

Such services are undeniably convenient for those who can afford them. Yet they also underscore the ongoing constraints in COVID-19 testing, which experts say is unfair for people of more modest means, and reflects wide gaps in insurance coverage for what's becoming a necessary tool for many people.

"It is a fast lane, like a priority queue at the airport where gold or platinum members get to cut the line and everybody else has to wait," said Carri Chan, a health care professor at Columbia Business School. "And because the demand right now is so high, especially with holiday travel coming up, the delays end up increasing quite a bit, which implies the benefit of charging premiums and cutting the line are that much more valuable." 

In New York City, for example, a number of clinics — including CareCube, Clear19, MedRite and others — tout same-day PCR tests geared toward people who are traveling abroad and need prompt results. 

For $225, CareCube, with 20 testing sites across the Big Apple, guarantees test results within eight to 10 hours. Sameday Health, also based in New York, guarantees a PCR test result in one hour for $250. For a fee of $400, My Doctor Medical Group, a private practice in San Francisco, says it will deliver a PCR test result by 9 a.m. the day after the test is administered. 

"The private jet of testing"

Clear19 Rapid Testing, founded in March 2020 in an effort to contain the virus before vaccines became available, offers the speedier molecular-based testing services for a premium. Clear19 uses a robotic lab that can process 90,000 specimens overnight, delivering test results to patients within 24 hours. 

"We are continually expanding capacity, and anytime there is a surge the lab can absorb the impact. That's why we can guarantee overnight results," said Sandy Walia, founder and director of Clear19.

The company also offers same-day testing, which Walia called "the private jet of testing." Clear19 doesn't work with insurers; instead, patients are responsible for the full cost of the service provided. The price for a rush test result? $389. Patients who can wait 24 hours to receive their PCR test results pay $175. 

"We run each individual sample for a two-to-three hour turnaround time versus the 'commercial fight,' which is the overnight service where tests get accumulated and finalized the next morning," Walia said.

Molecular tests are more sensitive than rapid antigen or lateral flow tests, meaning they detect the virus, including the Omicron variant, early and before an individual is contagious in some cases. They are gentle and non-invasive, meaning patients are no longer required to practically have their brains tickled with a long, thin nasal swab.

Walia expects that current strict testing requirements for travel, which vary by country, will eventually loosen, and demand for overnight and faster results will recede. But testing will remain crucial for preventing the global spread of new variants. 

"Do I anticipate a massive need? No. But if this thing is still around for a little while, testing will be the only way to prevent global spread," she said. 

Omicron "doesn't care if you're vaccinated"

Sameday Health, another testing outfit started during the pandemic, has also sought to expedite the turnaround time for COVID-19 tests. It operates clinics in 15 states that can deliver results within 12 hours for $175, according to Patrick Emad, the company's vice president of clinic operations. 

Emad, who says the self-funded company is already profitable, thinks demand for PCR testing will hold steady as cases of the virus remain elevated.

"I hope that we don't need as much testing as we do now and life returns to normal, but the trends we are seeing are an increase in testing nationwide and a strong increase in the percentage of positive cases. It seems Omicron doesn't care if you're fully vaccinated or have the booster, we are still seeing breakthrough cases in people who have their triple shot, and we are here if we are needed," he said. 

Experts say U.S. testing efforts continue to lag and that more government support is needed. Most insurance providers cover basic PCR testing services that deliver results in 48 hours, but that have proven inadequate for people who need their results faster than two days. Depending on the clinic and patient's insurance plan, a portion of the cost of the rush test may also be covered. 

Earlier this month, as part of its winter plan to battle COVID-19, the White House said it would require insurers to reimburse Americans for the cost of over-the-counter at-home tests, in addition to those that are administered at the point of care. 

"The testing landscape is still not where we need it to be at a time when we need testing to be ramped up and widely available with quick turnaround times," said Keri Althoff, a professor of epidemiology at Johns Hopkins Bloomberg School of Public Health. "There has to be broader testing availability regardless of income or where you are located." 

In New York, medical provider CityMD is advertising three- to five-day turnaround times for PCR tests, the costs of which are fully covered by most insurers, according to the drop-in health services provider. 

"Due to increased demand, the average turnaround time for PCR (Nasal Swab) lab results is currently 3-5 days, but can take longer depending on lab partner and other factors," its website reads. 

A five-day old test result is useless for someone who is en route to Canada, for example, which requires proof of a negative PCR test administered within 72 hours of takeoff. One reason for the widespread delay in delivering results likely has to do with staffing challenges, experts said.

"Most specimens go to big, commercial labs that are processing a very high volume, and the fact of the matter is we've had challenges in the supply chain and we have had exhaustion of staff and workers," Althoff said. "A lot of things lead to delays in the return of results, and it's a multifaceted problem. There needs to a broad strategic plan to monitor and ensure access to all types of testing and quick turnaround times."

Long delays can also make a test less useful if an individual has the virus and doesn't know she is infected. 

"That hampers the response because people who are infected maybe don't get the information back in time, and as a consequence end up exposing others unintentionally. That's where the inequality could be further exacerbated by this," Columbia University's Chan said.